GREAT HEALTH: Cholesterol Controversy Pt. 2

‘Cholesterol Controversy Part 2’ written by Dr Helena Popovic and published in Great Health Guide (October 2017). Cholesterol has always been a widely debated topic in the media. But do we really know the latest facts surrounding cholesterol? Is it cholesterol the villain it has been made out to be? In this second article of a two part series, medical doctor Dr Helena Popovic discusses the controversy surrounding the topic of cholesterol and clears up some misconceptions regarding diagnosis and treatment of high cholesterol.

Read other Great Health articles on Great Health Guide, a hub of expert-inspired resources empowering busy women to embody health beyond image … purpose beyond measure.

GREAT HEALTH: Cholesterol Controversy Part 2

written by Dr Helena Popovic

Cholesterol has received more media attention than most other biological molecules. This controversial lipid has appeared not once but twice on the cover of Time magazine. The first article in Time condemned cholesterol as a harbinger of heart attack. A few years later, cholesterol was exonerated with the exhortation to bring back the bacon. It’s time to reveal the private life of this public diva.

For decades cholesterol has been implicated as a major risk factor for heart disease and most people try to keep their blood cholesterol as low as possible. But is this the best way to lower your risk of heart attack and stroke? And are drugs or diet the way to go about it?

Older people with higher cholesterol levels actually tend to live longer and have a lower risk of Alzheimer’s disease than do people with low levels of cholesterol. This is not what we have believed for decades. 

What do we now understand about cholesterol?

1. Cholesterol is essential to life and each cell in the body can make it through a 37-step process. It’s a component of cell membranes and a precursor for making oestrogen, progesterone, adrenal hormones, Vitamin D and bile acids.

2. Cholesterol is also a vital part of the myelin sheath that enables signaling between brain and nerve cells. 

3. It plays many and varied roles in the body and is carried around in the blood by lipoproteins of varying size, weight and density.

Want your own FREE COPY of Great Health Guide

& delivered to your inbox each month?

Look to your right…

4. The cholesterol within each lipoprotein is the same – it is the carrier molecule that differs. The higher the protein to fat ratio, the denser the lipoprotein. Hence the terms HDL (High Density Lipoprotein) and LDL (Low Density Lipoprotein). 

However, the picture is far more nuanced than that.

HDL and LDL are only two of many lipo­proteins involved in cholesterol transport.

In decreasing order of density there are also:

• intermediate Density Lipoproteins (ILD), 

• very Low-Density Lipoproteins (VLDL) 

• chylomicrons. 

• each lipoprotein is designed to carry its cholesterol to a different location in the body to be used for a different purpose.

And here is where the controversies start. 

Traditional methods of measuring blood cholesterol were not able to differentiate between the different lipoproteins that transport cholesterol. We now understand that this is of critical importance.

• In the 1980s, we believed that the only thing that mattered was your total blood cholesterol level. This was a big mistake. 

• In the 1990s, we believed that HDL-C (High Density Lipoprotein-Cholesterol) was good (prevented heart disease) and LDL-C (Low Density Lipoprotein-Cholesterol) was bad (caused damage to blood vessel walls leading to heart attack). This is partly true. 

• HDL transports cholesterol to the liver for excretion or hormone production. This means that cholesterol is not floating around in the blood with nothing to do. The devil makes work for idle cholesterol. High levels of HDL-C show that cholesterol is being put to good use.

• With respect to LDL, in the last decade we’ve discovered even more subclasses that have differing effects on heart health. Small dense LDL-C is potentially harmful while light, fluffy (also described as large, buoyant) LDL-C is not. 

Small dense LDL-C particles are atherogenic (damaging to blood vessels) because they circulate in the blood with nowhere to go.

Eventually they get oxidised and taken up by cells called macrophages which become engorged and go on to form foam cells. These foam cells then become trapped in blood vessel walls and contribute to plaque formation. As the plaques enlarge, they bulge into the blood vessel cavity causing reduction in blood flow and eventually complete blockage. 

Furthermore, blood triglyceride (TG) levels are more predictive of heart disease than LDL-C. Body fat is mainly made up of triglycerides. What contributes to high TG levels in the blood? A diet high in sugar, refined carbohydrates and seed oils (sunflower, safflower, soy, corn and canola). Once again this is the opposite to what we have believed for decades.

So where does this leave us?

In 2012 the National Vascular Disease Prevention Alliance published new guidelines for measuring the fats in your blood. Instead of focusing on HDL and LDL alone, the tests that best predict a healthy heart are the following:

1. HDL-C — above 1.0 mmol/L

2. Fasting triglycerides — below 2.0 mmol/L

3. Non-HDL-C — below 2.5 mmol/L

4. Total cholesterol/HDL-C ratio — below 2.2

Non-HDL-C includes cholesterol in all atherogenic (harmful) lipoprotein subclasses.

The essential take-home messages:

1. Next time you have a blood test for cholesterol, ask for the above four tests. If your numbers lie within the cut-offs listed, you have nothing to worry about in relation to your cholesterol. If your numbers are not what you want, read my previous article entitled Cholesterol in the Spot Light Part1.

2. As we learn more about fats in the blood, different tests may be developed. Nothing in medicine stays static. For now, the above is your best bet. 

Please remember that by far the most powerful ways of lowering heart disease are:

• not smoking, 

• exercising regularly 

• reducing trans-fat, alcohol and sugar consumption.